Key findings
Diagnosis: GP
The first port of call for many patients concerned about their health is their GP. However, only 7.2% of patients we surveyed were diagnosed with heart failure in primary care, 2 with 36.3% diagnosed in hospital after a GP referral.2 More than half of patients said they were diagnosed by a cardiologist or heart failure nurse after being admitted into A&E or an emergency department (39.2%),2 or from a cardiologist as an outpatient at hospital (11.4%).2
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In the context of a NHS committed to reducing health inequality, the gender differences highlighted in this document are both unexpected and alarming. It is critical that we take stock of these findings while seeking to understand why women appear to be significantly disadvantaged when making a timely, accurate diagnosis of heart failure and commit to taking urgent action to address this.

"Delay in diagnosis is particularly relevant to primary care and though the presenting symptoms of heart failure are non-specific and commonly seen in other conditions, there is clear evidence that this diagnosis is not being considered at an early stage where investigations such as natriuretic peptide testing (NT-proBNP) are critical to further assessment and, where indicated, urgent referral. Access in primary care to NT-proBNP may not be universal but the use of the test when available appears to be highly variable and another important factor in late diagnosis.
"COVID-19 has led to significant changes in service delivery in primary care, altering the ways in which we consult and adding to the challenges faced in making a timely diagnosis of heart failure. Therefore the widespread use of cost-effective diagnostic tools such as NT-proBNP must be our priority to save lives, reduce costs and improve patients’ quality of life in the future."

Dr Jim Moore, General practitioner with special interest in cardiology, Gloucestershire Heart Failure Service and President, Primary Care Cardiovascular Society

NICE guidelines19 and the NHS Long Term Plan20 both emphasise the need for earlier diagnosis in primary care, which can be achieved through the use of NT-proBNP, which either rules out heart failure or enables referral to hospital for an echocardiogram.21 Despite being available for use in primary care, less than a third (29.1%) of patients said their GP ordered a blood test to test for heart failure.2 In over half of cases, someone other than the patient’s GP ordered the test.2 Overall there were also differences between male and female patients: 85.8% of men received a blood test, compared with 71.9% of women.2
In fact, it takes on average nearly three months (10.9 weeks) from a patient’s initial GP visit to diagnosis2 – and it can take much longer depending on where they live. While more than three quarters (79%) of Londoners could expect their diagnosis within a week,2 this dropped to 25.9% of respondents in Yorkshire and the Humber.2 In a handful of cases, patients waited between 12 and 14 years to get a formal diagnosis of heart failure.2

The gender divide is also striking and unacceptable. Gender inequality has been recognised in relation to heart attacks,22 but less so for heart failure, and there are clear parallels. While our research found men wait on average 3.6 weeks for their diagnosis, women wait over 20 weeks – a near-six-fold increase.2 Delaying hospital treatment by as little as four to six hours after symptoms of heart failure appear can increase the chances of death23 yet more than one in 10 women (10.7%) spend more than six months waiting for their heart failure diagnosis.2
Table showing diagnosis setting from Censuswide data.2